Practicing on the deceased: ‘I get it’

The human body is an ideal training tool, but fire/EMS training protocols and the law must be followed

By David Givot

Not only was it wrong, it was potentially criminal. That is the first thing I have to say in response to the report about the Bellingham (Wa.) Fire Department crew who took a deceased patient to Fire Station 1, ostensibly to await pickup from a funeral home, and allowed several department members to practice intubations on the body.

Under Washington law:

A paramedic demonstrates how to intubate a patient during training. (Photo/Wikimedia Commons)

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Officials said several department members practiced multiple intubations on a body that was awaiting transport to a funeral home

“Any person, not authorized or directed by the coroner or medical examiner or their deputies, who removes the body of a deceased person not claimed by a relative or friend, or moves, disturbs, molests, or interferes with the human remains coming within the jurisdiction of the coroner or medical examiner as set forth in RCW 68.50.010, to any undertaking rooms or elsewhere, or any person who knowingly directs, aids, or abets such unauthorized moving, disturbing, molesting, or taking, and any person who knowingly conceals the human remains, shall in each of said cases be guilty of a gross misdemeanor.”

Clearly, under Washington law, moving a body and using it – without any type of consent – for training purposes is enough to send each participant to jail. But should any of the personnel involved go to jail? I don’t think so. However, the opinion that matters is that of the prosecutor, and prosecutors are not known for infusing subjectivity, compassion or non-criminal-intentions into decisions about who gets charged in criminal court. If there is a law and the law is broken, they will prosecute you, no matter who you are or what your job is.

Moreover, in Washington, there is a governing agency that oversees – and disciplines – paramedic licenses. Likewise, in Washington, when a paramedic breaks any law, there can be grave consequences.

Training protocols must be followed

The second thing I have to say is: I get it. Most, if not all of us, practiced intubation on cadavers or on the bodies of the recently deceased in a controlled, hospital environment under the supervision of a physician. We know that there is no better training tool than a real human body, and that practicing on the dead helps us save lives. However, there are rules that govern when, where, how and upon whom this type of training takes place. There are protocols guiding such training techniques and, if the system is going to work, protocols must be followed. That is the law.

We don’t get to make up the rules or bend them to suit our purposes. This story reeks of the kind of departmental-culture issues that have plagued the industry and stunted the ability for EMS to grow at a normal rate from day one. Use common sense!

Public safety personnel are held to a higher standard because they have invited society to do so, and that is the lens through which fire/EMS providers are and will continue to be viewed. However, despite the high degree of responsibility, high standards and the celebrity-like regard that most people have for fire/EMS providers; firefighters, paramedics and EMTs are people; humans who, like all humans, make decisions that seem like a good idea at the time, but prove to be misguided. That is what seems to have happened here. I don’t see a need for blame, this is simply one of those “teachable moments” we have all come to dread.

I am as sure as I can be that the officers and crew members who thought taking someone’s dead family member back to the station for skills practice was a good plan, did so with the best of intentions. However, as we quickly learn in life, the road to hell is paved with good intentions. In this case, two veterans of the department lost their jobs and others will face discipline.

Fire and EMS are in the public spotlight

The takeaway is this: Just like every other decision one makes in EMS, each of us, on every call, and in every situation, must ask and answer these questions first:

If I am ever called to testify about my decision, action, conduct or statement, what will I say?

Would it make sense to a stranger in a courtroom or a TV news audience?

Is it clinically and/or legally justifiable in real life, not just in my mind?

Am I doing the right thing?

If those questions are too difficult or time consuming, do what I do. I ask myself whether I would still be doing what I’m doing, or saying what I’m thinking about saying if my father were standing right beside me.

I was not there that day, and the information I have is limited to that which has been reported, so I am not in a position to judge. Nevertheless, I am in a position to guide and to advise caution, calculation and conscientiousness in every decision.

The law has always been watching everything fire and EMS providers do, but in 2018, everyone is watching. Doing the right thing is not always easy, but it is always the right thing.